Pg. 26
The Enterprise of Healthcare
Keshav Desiraju Additional Secretary, H&FW, GoI
The revolutionary VScan
Pg. 17
volume 6 / issue 02 / february 2011 ` 75 / US $10 / ISSN 0973-8959 / www.ehealthonline.org
Steering India’s Health Sector Dr Naresh Trehan, Chairman & Managing Director, Medanta – The Medicity www.facebook.com/ehealth
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contents
Volume 6 | Issue 02 | February 2011 | ISSN 0973-8959 www.ehealthonline.org
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Cover story
Unprecedented Imaging Pg. 12
Divya Chawla
hospital CEO interview
08
“Medanta was built to aid India’s progress towards health self sufficiency”
Dr Naresh Trehan, Chairman and Managing Director, Medanta — The Medicity
product review
17
Saving lives is in your hands now! Literally!
a public health initiative like NRHM”
Keshav Desiraju, Additional Secretary, Ministry of Health & Family Welfare, Government of India
special report
30
Seeking the Right Perspective Divya Chawla
tech trends-ict
35
Byte of the pie
speciality
Healthcare Leaders’ Forum 2011
New Age Diagnostics
health secretary interview
26
4
“It took India over 50 years to invest in
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42
Dhirendra Pratap Singh
event report Dhirendra Pratap Singh
26
Dhirendra Pratap Singh
mHealth column
28
zoom in
Creating Efficient Healthcare Model
42
regular columns
Costing System in Hospitals
Ravi Mani, CEO, 21st Century Health Management Solutions
> www.ehealthonline.org > February 2011
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news review
S-Series™ MicroMaxx®
NanoMaxx® M-Turbo®
Ultrasound where you need it, when you need it. • F ull imaging capabilities across the spectrum of applications — including fluid drainage, abdominal, cardiac, superficial and procedural guidance • The industry’s only phased array probe with SonoMB™ multi-beam technology for high resolution abdominal and transthoracic imaging • Advanced imaging technologies across all products • Proven durability – capability to withstand a 3 foot drop onto hard surfaces • F luid resistant user interface for easy cleaning and disinfection
Parasternal long axis, captured with the M-Turbo ultrasound system using the P21x/5-1 MHz transducer
• Proven reliability – 5 -Year Standard Warranty • Connectivity – wired or wireless transfer of image data, DICOM®, USB or SiteLink™ See how versatile ultrasound can be, visit www.sonosite.com, or call +91 124-2881100
See us at the International Critical Care Congress Conference and Workshop 16th – 21st February 2011, Venue: Vigyan Bhavan, New Delhi.
World leader and specialist in hand-carried ultrasound.
Direct in India
SonoSite India Pvt Ltd Unit 603, 6th Floor, Tower B, Global Business Park, Gurgaon 122002, Haryana, India Tel: +91 124-2881100 Fax: +91 124-2881110 E-mail: india@sonosite.com
Gallbladder, captured with the M-Turbo ultrasound system using the C60x/5-2 MHz transducer
www.sonosite.com
©2010 SonoSite, Inc. All rights reserved. Subject to change. 02/11
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6
> www.ehealthonline.org > February 2011
editorial
Volume 6 | Issue 2 | february 2011 www.ehealthonline.org
Peeping into the future The past few decades have witnessed consistent technological evolution in the field of radiology with the development of several newer technologies. Following the trend, ultrasound, one of the oldest and most crucial imaging modalities, has made a mark globally with the recent surge in its application areas. The advent of 4D imaging and ultra-portability has provided physicians with an imaging tool that redefines the way body scans are performed. Valued at `485 crore in 2009 and expected to cross the `1100 crore mark in 2015, ultrasound market is set to capture a major chunk of the radiology market in the coming years. With all this, it is evident that the future of ultrasound scanning is here. Read more about the latest trends, technologies and application areas of ultrasound in the Cover Story of this issue. President: Dr. M P Narayanan Editor-in-Chief: Dr. Ravi Gupta Managing Editor: Shubhendu Parth VP - Strategy: Pravin Prashant Editorial Team: Dr. Prachi Shirur, Dr. Rajeshree Dutta Kumar, Divya Chawla, Sheena Joseph, Pratap Vikram Singh Sales & Marketing Team: Debabrata Ray, Arpan Dasgupta (Mobile: +91-9818644022), Bharat Kumar Jaiswal, Fahimul Haque, Rakesh Ranjan (sales@elets.in) Subscription & Circulation: Gunjan Singh Mobile: 9718289123 (subscription@elets.in) Graphic Design Team: Bishwajeet Kumar Singh, Om Prakash Thakur, Shyam Kishore Web Development Team: Zia Salahuddin, Amit Pal, Sandhya Giri, Anil Kumar IT Team: Mukesh Sharma Events: Vicky Kalra Editorial Correspondence: eHEALTH, G-4 Sector 39, NOIDA 201301, India, Tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided.
Going further, capturing the leaders’ thoughts in this issue, eHealth covers an exclusive interview with Dr Naresh Trehan, the most coveted names in the Indian health sector. Being one of the key drivers of the health of the nation, Dr Trehan is now working towards making quality healthcare available to every person in the country through his recent endeavor—Medanta. Reflecting upon the government’s vision and focus on health, Keshav Desiraju, Additional Secretary, Health & Family Welfare, Government of India, in an interview with eHealth has shared his thoughts on the key challenges that hamper health of the nation and solutions that can change the way India delivers health to its people. With our aim to enhance the penetration of IT in healthcare, we bring you a story on health management information systems (HMIS). The story focusses on the vast benefits of HMIS, through case studies of government projects that have deployed HMIS and benefited in a big way. The technology has emerged as a crucial tool for patient data storage and management, providing access of right information to the right people and automating complex tasks and workflow at the public health level. We hope you like the compilation!
ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at R P Printers, G-68, Sector-6, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.
Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org
February 2011 < www.ehealthonline.org <
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Hospital CEO interview
“Medanta aids India’s progress towards health self-sufficiency” Dr Naresh Trehan, Chairman and Managing Director, Medanta – The Medicity, is one of the most respected, admired and talented cardiologists in India. Dr Trehan is now working towards making quality healthcare available to every person in the country through his recent endeavor— Medanta. In conversation with Divya Chawla and Dhirendra Pratap Singh, he speaks about his journey and the key issues that affect the Indian healthcare industry today
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What was your objective behind starting a world-class affordable healthcare facility like Medanta in India? During the earlier days of my career, I was practicing in the United States and was well settled there. However, I always believed that India has all the ingredients for being a great and progressive nation, but it is not disciplined enough to achieve this. For this reason, there has always been a big gap between what it should be able to do and what it is actually doing. In India, patients were dying because of lack of appropriate facilities and nobody was able to do anything. In the US, with availability of latest technologies and trained manpower, 99 percent of lives were saved. Patients from India used to visit me in the US to get their heart surgery done and that cost them ten times more than the usual cost. It was then that we built Escorts Heart Institute in 1988 to provide world-class facilities for heart patients in India. From 1998–2003, India changed drastically with several technological advancements and developments. It was then, that the need for institutions, which not only offer the highest end treatment but can also be the fountainhead of knowledge with new therapies, in India. We wanted to develop institutes like Howard, Cleveland and Mayo in India and therefore we built Medanta as a next step in India’s progression towards healthcare self sufficiency. The whole purpose of my life has been to make the highest-end facilities available in India. We already had the skills for
> www.ehealthonline.org > February 2011
doing that and through Medanta, we built the infrastructure and technology. Further, we have been fortunate enough to have the best doctors join us as Chairmans of respective divisions in the centre. Having achieved all this, our next biggest purpose was to provide treatment at affordable costs and all of us agreed to bring down the cost as much as possible, although this was difficult from the business point of view. Being a world-class institute, how is Medanta focusing on research and development? How much of the total budget is allocated for research? If we talk about affordability, if America with 300 million people and more than US $ two trillion spend on healthcare can not afford to give appropriate health services to its people, then how can a country like India can give service to its people at affordable cost. So, there is an urgent need for developing countries to come up with new therapies which are good, equally effective, less traumatic to the human body and at least at half the cost. With this endeavour, we are now developing newer therapies using power of traditional medicines incorporated with modern medicines in the coming 5 to 10 years which not only India, but also countries like United States can use. Medanta is currently focusing on researches in neurosciences and Parkinsons disease. Ten percent of our budget automatically goes to research and this will progressively increase.
Hospital CEO Column
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Dr Naresh Trehan Chairman and Managing Director Medanta â&#x20AC;&#x201D; The Medicity February February 2011 2011 << www.ehealthonline.org www.ehealthonline.org <<
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Hospital CEO interview are also getting patients from Europe, Canada and the US. How many in and out patients do you get, at Medanta, in a day? On an average we get 1200 out-patients and 120-150 admissions/discharges in a day. As of now, what are the different technologies installed at Medanta? In the medical technology space, we are using high-end technologies such as handheld ultrasound equipment from Sonosite. In the health IT space, we have a Picture Archiving and Communications System from Siemens installed. Health IT has contributed tremendously to patient safety. With the help of health IT solutions, one can do all sorts of monitoring remotely for every treatment available. You could be sitting there at home and avail the benefits. Moreover, telemedicine and video conferencing have multiplied these benefits.
India needs approximately 50,000 doctors a year. To achieve this target, we need to almost double our infrastructure. India is not achieving the potential it can and to do that in the health sector, it needs to align prevention, primary, secondary, tertiary, research and education sectors together With all your endeavors, have you succeeded in making India the healthcare destination of the world? Naturally India is the healthcare destination of the world; however, there are many lacunae, for instance poor infrastructure. We can still offer treatment which is even better than what is offered in the United Sates. We have the means, the expertise and the technology and we have patients coming to us from all over the world. How many patients, on an average, are coming to Medanta from foreign countries? Almost 20 percent of our patients are coming from other countries including Burma, Pakistan, Afghanistan, and Thailand. We
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How has the field of Cardiology grown in India and what have been the innovations in this field in the last decade? Cardiology has made good strides. If we see knowledge-based techniques, then India probably ranks number one in Cardiology. Heart being a very critical organ of the human body, all healthcare providers including smaller hospitals are giving greater priority to it. We are now moving towards less invasive and preventive therapies. Since our knowledge is improving, we are also focusing on preventive measures in cardiac diseases. As far as angioplasty is concerned, invasiveness and better things are happening. We are doing surgeries like bypass
> www.ehealthonline.org > February 2011
without using machines. There have been many technological improvements in Cardiology. Research has improved to a level where we can do heart surgery with 99.8 percent accuracy. Similarly other fields are also progressing. At Medanta, new technologies have helped improve the accuracy of neurosurgery by 30 percent. Unfortunately, these newer technologies are very expensive, but the human benefits they offer are very huge. Further, liver transplants have come a long a way and the results of liver transplant have improved tremendously. We are also about to include heart transplant. The biggest challenge is to lower down the cost of these technologies. Despite being one of the fastest economies in the world, India still has 30 percent people living below poverty line with no access to proper health services. In such a scenario, what should be the role of government as well as health leaders to bring about the change? India needs approximately 50,000 doctors a year. To achieve this target, we need to almost double our infrastructure, if we talk theoretically. India is not achieving the potential it can and to do that in the health sector, it needs to align prevention, primary, secondary, tertiary, research and education sectors together. Another challenge is that currently primary and private sectors are not working in a cohesive way. The problem is that we are not moving fast enough to achieve the required target and therefore we need to act on all these issues immediately. What is your dream and who is your idol? My dream is to make quality and affordable healthcare service available to every Indian. Professionally, I admire Dr Frank Spencer and try to follow his footsteps; while I consider Dalai Lama as my spiritual guru and my father as my idol.
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cover story
Unprecedented Imaging Ultrasound technology makes a global impact with consistent technological evolution and recent surge in application areas By Divya Chawla
w
hen the global economy was seeing a major downtrend over the past few years owing to recession, the healthcare market continued to grow despite the global meltdown. This held true for almost all sectors within the healthcare industry including radiology equipment. Ultrasound, which forms one of the oldest and
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most crucial radiology segments has been a part of this successful growth story. The ultrasound market in India was estimated at `485 crore in 2009. Going further the market size is expected to exceed the `1100 crore mark by 2015 with an estimated CAGR of 13-14 percent. The ultrasound systems, in India, are priced somewhere between `70 lakhs to `1.5 crore. The global
> www.ehealthonline.org > February 2011
market for ultrasound was valued at a massive US $2.9 billion in 2009 and is expected to become double its size by the end of 2012. The growing trend of miniaturization and increasing trust in portable systems has led to a significant increase in the market of hand-carried ultrasound systems in the recent years. Although the western countries were the first ones to adopt this technol-
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cover story ogy, yet other regions of the world such as Eastern Europe, Latin America and parts of the Asia Pacific including India, are now beginning to show significant interest in this equipment. In the traditional ultrasound systems market, colour Doppler equipment accounts for a major chunk, while black and white scanners are now beginning to slowly fade out. Within the colour Doppler equipment market also, the mid-end segment is experiencing the greatest growth. While owing to the recessionary trends, the low-end segment and cart-based systems are also experiencing significant growth. The high-end segment is however, moving slowly, but is expected to catch-up as the economy emerges from recession. The greater interest of buyers in mid-end and low-end equipment as compared to high-end equipment is because of the increasing functionality and picture
“The performance, size, durability, ease-of-use and cost-effectiveness are the prime advantages of SonoSite’s hand-carried ultrasound system”
Pavan Behl Country Manager SonoSite India
quality of systems at the lower end of the market. In a way, the equipment prices in the ultrasound market have also been stabilized because of the improving quality and functionality of lower-end systems. Some of the key drivers for this
Projected Growth in Indian Ultrasound Market In `Crore
1500 1000 500
1125
485
0 2009 2015
Year
India’s Share in the Global Ultrasound Market 2009 (in `Crore) 3.70%
Global Ultrasound Market Indian Ultrasound Market
explosive growth include flexibility, easeof-use and lower costs as compared to most of the other imaging modalities. The overall ultrasound market has undergone tremendous product innovations such as decreased boost up times, increased battery backup, and stronger service contracts and warranties for probes that are positively affecting the future market penetration of ultrasound systems. There has been a rise in the number of handcarried ultrasound equipment for specific procedures such as nerve blocking, musculoskeletal and breast imaging. One of the key drivers for growth in countries like India and China, in particular, is the booming population. As Pavan Behl, Country Manager for SonoSite India, one of leaders in hand-carried ultrasound technology put in “Healthcare infrastructure is developing rapidly across India and the medical fraternity is gradually becoming aware of the advantages of using these systems in terms of timely diagnosis leading to faster patient recovery and saving vital lives.” Further owing to an increased awareness of the advantages offered by portable color ultrasound systems, and an ever increasing number of radiologists and physicians, India will continue to present growth and investment opportunities for ultrasound manufacturers in the future. According to Dr Kishor Taori, President, Indian Radiological & Imaging Association (2010) and Head, Department
February 2011 < www.ehealthonline.org <
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cover story
“The government and doctors must take the onus of educating others about the good diagnostic capabilities of ultrasound” Dr Kishor Taori President, IRIA (2010) and Head, Department of Radiodiagnosis Government Medical College, Nagpur
of Radiodiagnosis, Government Medical College, Nagpur, “The Indian ultrasound science is at par with the global standards. The manufacturers have responded in a very positive way and growth is evident in all segments.” Commenting on the cost of the technology, he added, “Prices of ultrasound equipment have really come done, which is a very good thing in the India market.” PV Jose, General Manager, Medical Electronics, BlueStar India said that, “Economic viability of ultrasound Technology, excellent diagnosis, patient awareness and local support services are the key growth drivers for ultrasound.”
Technology Trends The most upcoming technology in the ultrasound segment is miniaturization. Commenting on the benefits of handheld ultrasound machines, Dr Bharat Aggarwal, Director, Medical Operations, Diwan Chand Satyapal Aggarwal Imaging Research Centre, said “Hand-held ultrasound is going to be an important tool for gastroenterologists as instead of palpating the liver they can easily use the hand-held machine to view the liver. It can also be used by the gynaecologist to have a look at the uterus.” He further added that, “The hand-held system can act like an extended diagnostic tool, which is readily available with the clinician.” Pavan Behl said “Hand-carried ultrasound is an essential, everyday tool in clinical practice. Today,
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ultrasound visualization for procedural guidance is becoming a standard of care among many non-traditional ultrasound user groups, including emergency medicine, breast surgeons, intensivists and anesthesiologists.” With the recent technological explosion, the new dimension in ultrasound scanning has arrived. From 2D to 3D to 4D, the ultrasound, which once provided only black and white images, is set to revolutionalise the way clinicians see unborn babies. A 4D ultrasound takes multiple images in rapid succession, creating a three-dimensional motion video, which is invaluable for diagnosis purposes. The difference between 3D and 4D ultrasound is real-time imaging. Further IT implementation in ultrasound machines and customized sophisticated software have allowed for network connectivity in portable hand-held devices. A fully digital 4D ultrasound system is set to provide an integrated solution for medical imaging applications, allowing practitioners to provide faster treatment and improve therapeutic success rates. “The government and doctors must take the onus of educating others about the good diagnostic capabilities of ultrasound” There has recently also been an emergence of sophisticated technologies and software that allow physicians to view ultrasound images on their PDAs. This is much needed in a country like ours, where
> www.ehealthonline.org > February 2011
a major chunk of the population is living in rural and remote areas without basic access to healthcare services. This allows technicians to take ultrasound scans and send them via IT-enabled services to specialists stationed far away, who can analyse them at any point of time from anywhere. Further, this technology can also come handy in emergency situations, which requires immediate attention of a doctor, in a certain situation. Ultrasound images can be sent to the specialist in no time, which allows reducing the analysis time to a huge extent. However, the technology has certain drawbacks as well. Commenting on the key issues related to use of PDAs for ultrasound scanning, Dr Bharat Aggarwal said, “A lot of IT vendors are developing technologies to see ultrasound images on PDAs. However, these images cannot be used for diagnostic purposes because they offer smaller-sized images and lower resolutions. Hence, PDAs can be used for viewing and advising purposes but not for diagnosis.” Liver elastography is one of the recent innovations in ultrasound that allows detecting liver diseases with the help of ultrasound scanning. The major advantage of this technology is its price, which is much less as compared to CT and MRI procedures. India being a cost-sensitive market, a low-priced technology always has an edge over the expensive ones. Moreover, since liver diseases are highly prevalent in our country, a low-cost technology for detecting these would definitely have significant growth prospects. Sharing his perspective on elastography technology, Dr Bharat Aggarwal said, “We are keenly looking at ultrasound elastography—both liver and breast, as it is currently one of the latest technologies in ultrasound segment.” So to say, ultrasound technology is set to take over the radiology market with its consistent and unprecedented growth. As India is one of the fastest growing economies in diagnostic imaging this trend is going to continue in future as well coupled with a technological explosion.
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PRODUCT MATRIX
Ultrasound Product Matrix Portable and HandCarried Ultrasound
Blue Star
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BPL Healthcare
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Esaote
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GE Healthcare
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L&T Medical
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Mindray
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Philips Medical
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Sanrad Medical
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Shimadzu
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Siemens Healthcare
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SonoSite
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Toshiba
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Trivitron
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United Medical Instruments
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*This list is not exhaustive
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Others
Cardiology Ultrasound
Radiology Ultrasound
Vendor
Obstetrics/Gynecology Ultrasound
Segments
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Product Review
Saving lives is in your hands now! Literally! VScan is a powerful new diagnostic tool, which is revolutionalising the way healthcare is delivered
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s a healthcare professional, you deal with a number of life and death situations every day. Have you ever wished for tools that can help you take a quick look inside a body to save the lives? Precious lives are at stake every day as people have to be taken to facilities far away or specialised centres for taking a look at what’s going on inside the body of a patient who is experiencing emergency situations like cardiac attack, accidents/trauma etc. A powerful new diagnostic tool is revolutionising the way healthcare is being delivered today. A tiny high-tech device that’s so small, you could put it in your pocket, is helping heart patients. The smart-phone sized device is called “Vscan” from GE Healthcare. It can instantly tell the doctors what’s going on with your heart. It is not a stethoscope, provides visuals of your inner heart health and has clearly taken out the guesswork. It is a friend in deed to help save precious lives, saving people from serious disabilities! Vscan is redefining patient care definition in the medical history of India. It is an invaluable tool from an emergency physician’s perspective. It has the ability to be the first point of detecting disease conditions, even in primary care settings.
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S Ganesh Prasad, Director, Ultrasound Business, GE Healthcare South Asia, said, “Technology inventions can play a critical part in bridging these huge gaps that is deterring a healthy India. Healthcare in India is poised for new dimensions with the introduction of Vscan pocket visualisation tool. We believe miniaturisation of technology is the need of the hour for providing rapid access to advanced healthcare for more people at reduced costs. Recently we designed miniaturised ECG systems in India to provide care at the doorstep of people and today we have continued to move forward with Vscan.” Vscan leverages GE’s high-quality black and white image technology for anatomy and color-coded blood flow in a device that fits into a pocket. It weighs less than one pound, 3 inches wide and 5.3 inches long. Vscan may prove invaluable for physicians in today’s busy practice environment including primary care physicians and those specializing in cardiology, emergency/critical care, women’s health, pediatric as well as hospitals. GE’s Vscan was introduced in February 2010. Roughly the size of a smart phone, Vscan houses powerful, ultra-smart ultrasound technology that provides clinicians with an immediate, non-invasive method
> www.ehealthonline.org > February 2011
to help secure visual information about what is happening inside the body. Vscan is portable, battery operated and can easily be taken from room to room to be used in many clinical, hospital or primary care settings. It changed the definition of portable ultrasound, which previously referred to rather large laptop sized devices. Despite its small dimensions, the Vscan includes features such as power Doppler, and the device is powerful for most applications including emergency medicine, cardiac and obstetric ultrasounds. “Vscan is a breakthrough innovation from GE Healthcare and has the potential to redefine frontline healthcare practice and patient management with its ability to give non-invasive, visual information of the inside body in real time. Vscan is designed to be complementary to the stethoscope, to help physicians go beyond what they can hear to what they can see. Vscan may become as critical as a stethoscope to a physician in helping to detect disease more quickly. We believe Vscan can reduce the need for more tests and referrals during physical examinations and could make healthcare more accessible to people in India. Vscan naturally echoes
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Product Review
our healthymagination commitment to bring high quality healthcare at lower cost to more people around the world” said V Raja, President & CEO, GE Healthcare South Asia. Among other functions, Vscan has proved to be a valuable teaching tool. Students appreciate the ability to correlate auscultatory and clinical signs with echocardiographic findings at bedside. This very effective technique can enhance their learning experience. “The most common practice we (physicians) follow to assess health is to monitor pulse and listen through a stethoscope. To make rapid diagnosis, especially critical, in life threatening situations we need to take a look inside the body. Every minute saved can save a precious life. I wish every physician has a valuable visualization tool like GE Vscan that becomes his/her pocket buddy to help save lives in critical situations. A tool like this can help facilitate detection of diseases at an earlier stage and help people lead a healthy life” said Dr PC Reddy, Executive Chairman, Apollo Hospitals. “With a high quality visualisation tool like Vscan, early detection of cardiac disease is possible, during primary check ups. By looking inside the body, a physician can identify whether the chest pain
The Vscan is already allowing emergency medics to assess internal injuries on the way to the hospital. And doctors can take a quick look at a person’s heart murmur within minutes, rather than waiting hours or days for an appointment with an ultrasound technician. The Vscan could soon become as ubiquitous as the stethoscope.
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Mitral Valve Calcification PLAX View
MV Calcification Apical 4ch. View MV Regurg due to calcification
or breathlessness of the patient is due to a respiratory issue or a genuine cardiac problem” said Dr Devi Shetty, Chairman, Narayana Hrudalaya, Bangalore and advisor for GE’s healthymagination initiative. “In accident and trauma cases, quick visualisation plays a critical &important part in saving lives. The first 15 minutes to one hour can decide whether the victim or patient would survive or not. Ultrasound, being the only visualisation technology that provides real-time imaging and can be used at the point-of-care has emerged as a crucial tool for quick diagnosis in accident cases. A tool like Vscan, which can fit into the pocket of emergency physicians provides additional information for saving lives in our country where one person dies every 5-6 minutes in road accidents and millions of people whose first warning of cardiac problems is death from a cardiac attack,” added Dr Shetty. “Vscan is an excellent tool for an emergency physician. Vscan can be in his pocket, at his reach, available in the middle of the night, at odd hours, as soon as the patient needs, as many times the patient needs and it is right there to reassess the patient and make a difference. It helps substantiate our clinical suspicion or diagnosis within minutes of checking a patient. It is the most valuable tool I have experienced as an emergency physician”, said Dr Mahesh Joshi, Head of the Department, Emergency Department, Apollo Hospitals, Hyderabad.
> www.ehealthonline.org > February 2011
A Case Study from India Dr V S Srikanthan, Consultant Cardiologist, The Heart Centre, Pune, SD, 27 year old lady, was admitted to a hospital in Karad, a small town 150 km from Pune with exertional dyspnoea. She was evaluated by the local cardiologist and found to have a tight mitral stenosis. The valve anatomy was considered suitable for percutaneous valvuloplasty (BMV). A senior interventional cardiologist from Pune travels to Karad once a week for interventional procedures. The patient was admitted on that day for the BMV. Since she was scheduled for the first case on that day, she was shifted into the cath lab and prepared for the procedure. The Cardiologist was carrying the VScan echo machine with him so he did a quick assessment on the table prior to the procedure. To his surprise he found a large chunk of calcium on the tip of the anterior mitral leaflet and some calcification of the posterior leaflet. The high resolution imaging with the VScan helped detect a problem that could have resulted in a major complication. The presence of calcium on the leaflets increases the risk of failure and complications associated with BMV. The procedure was abandoned and the patient was advised to go for an open valve repair. The easy portability, the high resolution images and the good colour flow are of great advantage to cardiologists who travel a lot and visit remote centres for patient care.
knowledge for change
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event report
Healthcare Leaders’ Forum 2011 Creating Sustainable Leadership The Healthcare Leaders’ Forum 2011 organised by eHealth magazine highlighted strategies and steps that will carry forward successful healthcare delivery in India By Dhirendra Pratap Singh
e
Photo by Jaydeep Saha and Anil Chandhok
health magazine organised the Healthcare Leaders’ Forum on January 14, 2011 in New Delhi with an aim to create a pulsating platform for leaders of the healthcare industry to connect with each other, share ideas and best practices and prepare for the demands of the new era in healthcare. Also celebrated at the occasion was the launch of the 50th issue of eHealth magazine. Launched in November 2006, eHealth has established itself as a leading
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monthly magazine on healthcare ICTs, medical technologies and applications in India as well as Asia Pacific. Celebrating the success of eHealth and marking the beginning of a new era, the 50th eHealth issue was launched by eminent dignitaries including Keshav Desiraju, Additional Secretary, Health & Family Welfare, Government of India; Dr Ajay Kumar Singla, Additional Secretary (H&FW), Govt of NCT of Delhi & CEO, Aapka Swasthya Bima Yojana; Dr Ashok
> www.ehealthonline.org > February 2011
Kumar, Director, Central Bureau of Health Investigation & Dy DG, Central Health Services, Government of India; Amod Kumar, MNH Project Director, IntraHealth; Dr MP Narayanan, President, Elets Technomedia and Dr Ravi Gupta, Editor-in-Chief, eHEALTH.
Session One Dynamics of the Indian Healthcare Industry: Trends and Analysis
The inaugural session of the forum focused
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event report
on the key growth indicators and government’s initiatives that have paved way for a healthier future. With a projected combined annual growth rate of 16 percent and an estimated market size of US $75 billion by 2012, healthcare sector is expected to contribute as much as 8.5 percent of national GDP and employ more than 9 million people over the next couple of years. Much to the delight, growth is evident in all sectors of the healthcare industry and almost across all geographic regions of the country. Elaborating on the role of ICT in the growth and development of the healthcare sector, Keshav Desiraju, Additional Secretary, Ministry of Health & Family Welfare, Government of India stated that enormous amount of work is being done currently for IT application in health. He said, “A lot still needs to be done in health sector in India, especially use of IT in healthcare. Vast network of public health exists and we need to think about how we can improve it using IT. IT can help tackle issues of high rate of infant and maternal mortality.” He added, “Problem exists with health human resources in India that needs attention. The dilemma in India is there are huge differences in public and private healthcare, there is need to ponder on how to bridge the gap. Robust IT healthcare system with well motivated health professionals will pave the way for betterment.” It was highlighted during the session that role of IT enabled system is required to monitor the outcome of healthcare professionals in rural areas in India. Said Dr Ajay Kumar Singla, Additional Secretary (H&FW), Govt of NCT of Delhi & CEO, Aapka Swasthya Bima Yojana, “Lot of corruption prevails in public health sector and that’s the reality. If we aim at bringing equity, we need to tackle corruption. There is an erosion of trust in doctors; dearth of ethics prevails in health sector. We must give power to the people.” He added, “We need to strengthen the medical regulations. Private healthcare in-
Keshav Desiraju
Dr Shakti K Gupta
Additional Secretary, Health & Family Welfare, Government of India
Medical Superintendent & HOD, Hospital Administration, AIIMS
Dr Ajay Kumar Singla Additional Secretary (H&FW), Govt of NCT of Delhi & CEO, Aapka Swasthya Bima Yojana
Dr Om Manchanda
CEO, Dr Lal PathLabs
stitutions are world class in India. Arvind Eye Hospital is an example of providing quality healthcare at low cost.” Dr Ashok Kumar, Director, Central Bureau of Health Investigation & Dy DG, Central Health Services, Government of India said, “India has the largest public sector health network in the world. Reaching the remotest corner, with package of affordable healthcare is a challenge. We need to give highest priority to managing health related information.” However Amod Kumar, MNH Project Director, IntraHealth was hopeful that rural areas public health services would improve due to the positive developments in the country. He said, “TV, FM Radio are helping in health related communications in rural areas. Public-Private Partnership can help government to utilise private sector strengths in healthcare programmes. Power, literacy level, drinking water situation is improving in India. Rural BPOs are increasing and business enterprises shifting to rural areas.”
Keynote address Chetan Patnaik, DGM, Samsung delivered the keynote address, following the inaugural session. Focussing on the role
February 2011 < www.ehealthonline.org <
Dr Ashok Kumar
Director, Central Bureau of Health Investigation & Dy DG, Central Health Services, Government of India
Amod Kumar MNH Project Director, IntraHealth
Chetan Patnaik
DGM Samsung
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event report
Dr Pervez Ahmed
Dr Ankush Sabharwal
CEO, Max Healthcare
Director, Jeewan Mala Hospital
Surgeon Rear Admiral (Retd.) Dr VK Singh
Dr Ajit K Nagpal
Convener Task Force on Health Sector Reforms, Govt of J&K
Dr Sanjeev Bagai
CEO, Batra Hospital & Research Centre
Director – Healthcare Asia, Simpler of technology in healthcare, he said, “Samsung is a B2C company. We have set up an enterprise division, as a growth engine for the next ten years. We are developing a lot of solutions for healthcare and have launched new productivity devices. These devices have all the latest forms of communications.” He added, “We understand the need of the productivity and portability. Large screen of transfer and legibility of data is important. So, we have developed the Samsung Tab, solutions for EMR and solutions for Radiology.”
Session Two Vibhu Talwar COO, Moolchand Medcity
Dr Thumbay Moideen President, Gulf Medical University
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Private Sector’s Role in Creating Successful Healthcare Delivery
healthcare, Dr Pervez Ahmed, CEO, Max Healthcare highlighted that GDP spent in healthcare is less in India compared to any other country. “Solution to bridging the gap between public and private healthcare systems lies in technology. Anybody should be able to carry information without using his suitcase and this would be a big change,” he said. “Private people should come forward to improve healthcare in India. Government should give land free to private healthcare providers for hospitals. Three Ps - Population, Prevention and Perception are very important to tackle in healthcare,” said Dr Sanjeev Bagai, CEO, Batra Hospital & Research Centre. Dr Ajit K Nagpal, Convener Task Force on Health Sector Reforms, Govt of J&K said, “Public policy must drive the growth of healthcare sector in India. Universal access to basic healthcare forms the basis of public spending. Investment of private sector in health in India is driven by free market of economy.” Sharing the education sector’s role, Thumbay Moideen, President, Gulf Medical University said, “We are planning to set-up an Ayurvedic University in India and are exploring some set ups in Malaysia, Iran and Morocco, as well. Thus, we aim at having a global presence in healthcare education.” Vibhu Talwar, COO, Moolchand Medcity also reflected role of private sector in creating successful healthcare delivery centres. The session on private sector’s role in healthcare provided interesting food for thought.
Centres
In the second session, healthcare industry leaders reflected upon the private sector’s role in changing the face of healthcare in India. The private sector has played a tremendous role in shaping the healthcare sector in India. India has a deficit of around 30 lakh hospital beds right now and in future almost 80 percent of this deficit would be fulfilled by the private sector. Elaborating on the need to bridge the gap between private and public
> www.ehealthonline.org > February 2011
Session Three The Emergence of Accreditation in Assuring Quality Healthcare Services
Quality is crucial when it comes to healthcare and there have been numerous instances of poor care, inadequate facilities, unnecessary interventions and insufficient information that have called for a closer look at the healthcare delivery system in our country. The emergence of
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event report
We need a future vision in health care that is safe, patient centered, affordable for people,” said Surgeon Rear Admiral (Retd.) Dr VK Singh, Director – Healthcare Asia, Simpler.
Dr JS Suri
Dr Girdhar Gyani
Medical Director, Dr Suri Laboratories
Chairman, QCI
Session Four Transforming Healthcare with Innovations in Medical Technology and Diagnostics
Dr Uma Nambiar
CEO, SL Raheja Hospital
Dr Dharminder Nagar Managing Director, Paras Hospitals
Sudhir Bahl
President & COO, Nova Medical Centre
Dr Sanjeev K Chaudhary CEO, Super Religare Laboratories
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accreditation and the growing need for maintaining optimum standards is driving healthcare delivery centres to offer quality healthcare. In this session, speakers looked into the various parameters that have helped in developing quality through accreditation. Dr Giridhar Gyani, Chairman, Quality Council of India chaired the session and highlighted that accreditation and quality are two sides of a coin. “In healthcare delivery the level of expectation is very high. The quality that patients expect is the quality healthcare industry needs to provide. A healthy population is most important driver of national economy. Quality comes with care of the patients first. For ensuring quality medical care, accreditation is very important,” said Dr Uma Nambiar, CEO, SL Raheja Hospital. She added, “Accreditation is not the end point for desire of excellence, we need to drive at patient’s delight.” Said Dr Ankush Sabharwal, Director, Jeewan Mala Hospital, “Some form of quality assurance is necessary and accreditation leads to lowering of cost. There are mindset challenges to overcome for NABH for hospitals accreditation in India. With accreditation of Jeevan Mala Hospital not only quality has improved, but also attrition rate has come down.” Dr Dharminder Nagar, Managing Director, Paras Hospitals said, “A healthy population is most important driver of national economy. We need to have a benchmark of quality healthcare in India.” “If we adopt lean theory of quality, 1820% cost cut can be ensured in hospitals.
> www.ehealthonline.org > February 2011
Technology plays a crucial role in both diagnostics and therapeutics. As the Indian healthcare sector is undergoing constant evolution, technology penetration is growing by the day. The last session of Healthcare Leaders’ Forum focused on the role of cutting-edge technologies in all sectors of healthcare and the various issues that plague the Indian medical technology sector. “We need to balance wish-list of healthcare industry and the want-list of the community. Management of innovation in healthcare sector will involve creativity, critical scientific appraisal. We need to deploy need-based deploy in healthcare sector, that is the need of the hour,” said Dr Shakti K Gupta, Medical Superintendent & HOD, Hospital Administration, AIIMS. Sudhir Behl, President & COO, Nova Medical Centre, advocated for more day care surgeries. Dr JS Suri, Medical Director, Dr Suri Laboratories stated that we totally lack regulations for labs; it has to come from the state. Dr Sanjeev Chaudhary, CEO, Super Religare Laboratories and Dr Om Manchanda, CEO, Dr Lal PathLabs highlighted the need of regulations for effective innovations. Dr Sanjeev Chaudhary said, “There is need of regulations for effective innovations. We totally lack regulations for labs; it has to come from the state.” Dr Om Manchanda said, “IT is the core in the pathology space. On both quality and service side, there is need of IT deployment in healthcare sector. Chain of labs requires more technologies. Challenge for us is to connect all networks at real time basis.”
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Health Secretary Interview
Keshav Desiraju Additional Secretary Ministry of Health & Family Welfare, Government of India As the Additional Secretary with Health & Family Welfare, Government of India, Keshav Desiraju plays a pivotal role in transforming the public health sector in India. He shared his views on the key challenges that hamper the growth of the Indian healthcare industry and the government’s role in overcoming these challenges in a candid interview with eHEALTH in the sidelines of the Healthcare Leaders’ Forum
“It took India over 50 years to invest in a public health initiative like NRHM” 26
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Health Secretary Interview
The public health system in India is at the brink of a complete transformation with health becoming a priority for the government. What are your views on this? Public health has to be a public responsibility and there is no getting away from this fact. There is a vast network of public health facilities currently in our country. As Government representatives in health, our task really is to assure delivering quality health services to every Indian. While we talk of the public health sector, we cannot ignore the various public health issues which need immediate attention. On the one hand we have IT-driven surgeries and world-class standards in some of our hospitals, and on the other we have unacceptably high rates of maternal and infant mortality. This trend has now existed for a long time. We have concentrated all our energy and resources including human and financial on the high-end areas, leaving the low-end unattended. The Government did a tremendous task by setting up the National Rural Health Mission (NRHM) in 2005. This was the first time since independence that such a huge public investment of this order in the health sector happened. It took us over 50 years to put that kind of investment and the results are already visible. But again maternal and infant mortality are realities. We have malaria returning to those areas where it was believed to have disappeared from. So I believe that although a lot has already been done, we still have a huge task at hand. India still has a huge infectious disease burden. How can this problem be resolved? Infectious disease eradication traditionally was the heart of Indiaâ&#x20AC;&#x2122;s health policy, but there are still people dying with infectious diseases. Also, there is a whole range of life style diseases such as cardiovascular diseases and diabetes affecting a large number of people. A WHO survey suggested that almost 13 percent of the Indian popula-
The Government did a tremendous task by setting up the NRHM in 2005. This was the first time since independence that such a huge public investment of this order in the health sector happened. It took us over 50 years to put that kind of investment and the results are already visible tion suffers with some kind of mental illness; this is a colossal number. These are huge issues affecting the health of the general population. While we have stateof-art technology, IT enabled systems, etc., we need to do a lot more in getting these to work within the public sector to make a change in the health status of the country. What, according to you, is the biggest challenge India faces today in healthcare? India is currently facing a huge challenge of lack of human resources in healthâ&#x20AC;&#x201D; whether of basic physicians, specialists, super specialists, nurses or paramedics. There are problems of quality, numbers and willingness to work. This implies that we are trying to bring technology to upgrade what is basically a very flimsy system. If you have a strong system manned with high quality people, it is much easier to raise the standard of the entire institution. In the public sector, there are some examples of good functioning systems with well motivated people high-end technology, and high investments but unfortunately the average institution is not like that. Government hospitals, primary health centres, community health centres generally have very poor standards in terms of human resources. How can this issue of manpower be resolved? There are more than 316 medical colleges in the country, out of which more than 50 percent are in the private sector. Even out
of these 316 medical colleges, very few are producing MBBS doctors of good standards. If we see, 316 is a pathetic number for a country like India, but still if the standards were good this would not have been a problem. Most of these colleges are not churning out good doctors. Trying to work on this issue to upgrade the qualification and standard of the institution is very difficult; however it is not impossible. So we still have hope. How do the government hospitals fair, when it comes to offering care to the masses? If you go to hospitals like Ram Manohar Lohia, Safdarjung Hospital, AIIMS and Maulana Azad Medical College and see the condition in which our government doctors work with the amount of patient load they have, you would realise the tremendous work they are doing. It is a miracle that these doctors are still being able to carry on the good work. This means there is enormous experience and motivation in these doctors that makes them work well in such conditions. We know what needs to be done; what the modern world requires, but we also know what the situations are. This is the task that we have. It does me no good to know that there is an outstanding private hospital offering quality treatment in Delhi, but is overbooked. The word quality treatment does not mean anything if at the same time, I know there are hospitals in our country where three pregnant women have to share the same bed.
February 2011 < www.ehealthonline.org <
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mhealth
Creating Efficient Healthcare Model After taking the telecom sector by storm, mobile phones are set to change the way healthcare is delivered
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ireless connections have outpaced wired implementations in most parts of the world. The penetration of mobile devices in hard to reach geographies, has given the stakeholders in healthcare a reason to adopt this technology for delivery of healthcare. mHealth is quickly emerging as a channel that drives accessible, real time and efficient healthcare delivery. Mobile Healthcare or mHealth is a term for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless devices. mHealth applications include the use of mobile devices in collecting community and clinical health
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data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine). For the first time in India, a mobile phone doctor-to-patient service called ‘Doctor on Call’ was launched. The 9 to 9 service that provides live interaction was pioneered by BPL Mobile, Mumbai’s leading mobile service. Last year, Bihar State Government has announced to give free mobile phone services to its doctors in an attempt to reduce truancy. Many government doctors neglect their official duties by practising privately on the side. The main purpose of
> www.ehealthonline.org > February 2011
the move is to be able to get in touch with the doctors at any time. Their movements will also be tracked by a system. Scientists at the University of California, Los Angeles (UCLA) have created a cell phone that can monitor the condition of HIV and malaria patients and test water quality at disaster sites and undeveloped areas. UCLA electrical engineering professor Aydogan Ozcan has constructed the new innovative imaging technology, which has been miniaturised by researchers in his lab to the point that it can fit in standard cell phones. The imaging platform, known as LUCAS (Lensless Ultra-wide-field Cell monitoring Array platform based on Shadow imaging), has now been successfully installed in both a cell phone and a webcam. However, healthcare providers and operators/carriers are embracing mHealth to target and treat consumers suffering from chronic care/lifestyle disorders. For the providers, a chronic care patient is a “Big Ticket” patient who often needs follow-up consultations, frequent diagnostics, nurse and ancillary help. These patients also sign up for disease management programs and occasionally need surgical interventions which are money spinners. For the operators/carriers, providing mHealth services result in a revenue stream from value added services - long term subscription to tips, reminders, self care apps, IVR based self help contact centre solutions. The way forward is to shift the focus to driving medical value – mHealth solutions should build efficiency and must cut costs in healthcare delivery. Stakeholders need to collaborate to bring down technology costs and make it easier for the consumer to adopt mHealth solutions. A successful mhealth model should have a cross-carrier approach for the infrastructure; solutions should be handset independent and should work with a variety of connectivity standards (Bluetooth and GPRS) with minimal switching costs. Over the next few years, stakeholders will take advantage of the ubiquity of the mobile phone to develop and deliver mHealth solutions to everyone regardless of their financial or social position.
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Special Report
Seeking the Right Perspective Healthcare CIO Outlook Report 2011 The mindshare of CIOs of India’s leading healthcare organizations on IT strategy, technology roadmap, purchasing trends, evaluation priorities and a host of related aspects that concern the modern healthcare industry By Divya Chawla
D
espite being a hub for IT and IT-enabled services industry, India, in the past, lagged tremendously in the adoption of IT in hospitals as compared to the western countries. Studies suggested that large corporate hospitals in India spend less than 1 percent of their budget on IT, while countries in the west are spending somewhere close to 3 percent. The good news, however, is that in the recent past, there have been certain positive developments in this field that
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> www.ehealthonline.org > February 2011
“My IT vision is to leverage technology for improving patient care and efficiency of the clinicians”
Dr Neena Pahuja CIO Max Healthcare
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Special Report
Expectations from IT Solution
38%
62%
“The best IT structure in any organisation depends upon the perfect decision of the managers and their administrators’ support”
Flexibility
Sudhakar Manav
Standardisation
Vice President QRG Central Hospital & Research Centre
Basis for Choosing an IT Vendor
have provided the requisite impetus for much greater IT adoption in hospitals in India. Privatisation and corporatisation of hospitals coupled with growing awareness of the benefits of IT solutions is driving this trend.
25% 75%
The best quality provider
Macro Objectives of IT Implementation All hospitals have certain aims and objectives while implementing a health IT solution. While some look at the broader picture and opt for solutions that in the long-run would provide value to the functioning of the organisation, there are others who prefer solutions that provide immediate benefits. Almost all hospital CIOs surveyed for this report said that they preferred solutions that offered longterm strategic value rather than short term departmental process improvement.
The end-to-end deliverer
Expectations
Measure of Success of an IT Implementation
17%
83%
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“The Microsoft Dynamics NAV 4.0 solution at AIMS ensures greater transparency and control, saves billing time and reduces patient wait time”
Increase in service
Suvankar Pramanick
Increase in overall quality and customer satisfaction
Head – IT Asian Institute of Medical Sciences
> www.ehealthonline.org > February 2011
The basic requirement almost 62 percent of hospital CIOs from their health IT solution is standardisation. The remaining 38 percent prefer solutions that would provide flexibility over standardisation. This suggests that standardisation is one of the key demands of hospitals these days. When asked about her expectations from an IT solution, Dr Neena Pahuja, CIO, Max Healthcare said, “The top most goal for IT currently is to align with business and provide better quality of patient care. IT is expected to provide tools for collaboration and alerts for better patient safety standards.”
Selecting a Vendor Choosing the right vendor is crucial for hospitals. A wrong decision at the begin-
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Special Report Software Preference
14% 28%
58%
“Apart from the administrative advantages, the clinical advantages of a health IT solution are tremendous”
Commercially available off the shelf (COTS) software Customized Software
Dr Karanvir Singh
Mix of both
Head – HIS Implementation Sir Ganga Ram Hospital
Preferred Level of Interopersability
14% 58%
28%
To interoperate only with my existing IT solution To interoperate only with IT solution in affiliated/partner hospitals To interoperate with IT solutions of any and every hospital
Standard Requirement for Software
10% 11% 11%
67%
ning itself can hamper the benefits that the hospital would want to achieve from IT. It is interesting to note that despite India being a cost-sensitive country and hospitals keeping meager budgets for IT solutions, none of the CIOs chose the cheapest solution provider as a key requirement. Instead, almost 75 percent CIOs are actually looking for the best quality provider, and the remaining 25 percent expect that the vendor to be an end-to-end deliverer.
The Measure of Success The benefits of an IT solution are many. As put by Dr Pervez Ahmed, CEO, Max Healthcare, “An IT solution not only helps an organization in reducing cost and enhancing quality of services offered, it also has much in store for patients who are able to maintain their records online through electronic medical record solutions.” Almost 17 percent of hospital CIOs measure the success of a health IT solution on the basis of increase in services, while majority of them, around 83 percent, believe that increase in overall quality and customer satisfaction is the key to success.
Software Selection Should be compliant to all/most common Health IT standards Should be compliant to ICD Should be compliant to HL7 Should be compliant to Dicom
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A plethora of software options are available these days that add to the confusion of hospitals that have to choose the best solution that fulfils all their requirements. When asked about their preference, 14 percent of
> www.ehealthonline.org > February 2011
hospital CIOs would opt for commercially available off the shelf (COTS) software, 28 percent would opt for customised software and 58 percent would choose a mix of both for maximum benefit.
Interoperability For an IT solution to function efficiently in an organization, it has to be interoperable to an extent allows the hospital to connect with all required parties. Fifty eight percent of hospital CIOs believed that a best solution would be one which is interoperable with IT solutions of any and every hospital. Twenty eight percent would want the software to be interoperable with their existing IT solution, while the remaining 14 percent would choose a solution that is interoperable with their affiliate/network hospitals.
Standards A plethora of standards exist, today, for healthcare IT solutions that measure various levels of solution functionality including ICD, HL7, DICOM, IHE and SNOMED. Sixty seven percent of Indian hospital CIOs believe that standardization is one of the key requirements and a solution must be standardized to any of the standards that exist. ICD and HL7 standards were chosen by 11 percent CIOs each and 10 percent CIOs said that their solutions must be compliant with the DICOM standards.
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Tech Trends – ICT
Byte of the pie HMIS harnesses the power of information to bring quickest corrective action on ground for fighting any challenge in public health By Dhirendra Pratap Singh
I
mproving health conditions in rural areas has always been the biggest challenge in India. With an enormous land area spread across a staggering 3.28 million sq. km. and having nearly 70 percent of its teeming billion living in rural areas, providing equitable and efficient health services is surely a herculean task by any scale of measure. Not only does it require a huge funding base, but it also involves massive operations in terms of mobilising materials, medicines, human resources and physical infrastructure, required to deliver and administer health services. At the centre of all these lies an essential element— ‘information’. Flow of information and management of resources is critical for the success of any programme. Understandably, this is even more pronounced, when it entails the issue of public health. Starting right from policy makers, to programme man-
agers, to implementers and even for field health workers, information is a critical resource in understanding challenges, identifying gap areas and ensuring efficient implementation of the programme. Even up till recently, health data collected at village level took some few months to reach authorities at the Cen-
tre. With manual and semi-automated systems in place, it was almost impossible to receive information in a short time. This resulted in delayed response time for authorities and a high rate of data redundancy in the system. In turn, this led to create lacunae in public health planning by way of creating difficulty in
“HMIS enhances information integrity, optimises workflow and allows easy patient data recovery and storage consolidation” Dr TBS Buxi Chairman North Healthcare Diagnostics
February 2011 < www.ehealthonline.org <
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Tech Trends – ICT Case of Maharashtra
The goal of HMIS is to put data for action at the local level. To make this happen, we need data, analytical capabilities and authority to use this analysis for action on ground forecasting the accurate need for service provisioning, emergency preparedness and even resource mobilisation.
NRHM In a project as crucial as the National Rural Health Mission, inefficiency of any form, not only escalates costs but often proves critical in terms of human life and health conditions. Since public health has a direct bearing on national productivity and consumption, it makes sense to plug all holes to bring efficiency in a project which will invest as much as INR 12,050 crores/INR 120.5 billion in the current fiscal, with scope for higher allocation in successive years till 2012. Keeping this in mind, for NRHM health statistics information Ministry of Health and Family Welfare, Government of India in technical collaboration with iBilt Technologies launched HMIS (Hospital
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Management Information System) portal www.nrhm-mis.nic.in. Built to serve as a one-stop-site for the entire NRHM programme, the portal combines an array of cutting edge technologies that render superior data analytics, robust data warehousing and sharp business intelligence tools, which can allow decision makers to generate more frequent periodic reports and closely monitor the status of the health sector. Pravin Srivastava, Ministry of Health and Family Welfare, Govt. of India says, “The biggest strength of HMIS system lies in its ability to bring apparently disparate data sets and spatially distributed resources on one single platform. This has been achieved to the extent of even integrating the financial reporting system within the health information system. Getting both physical and financial information on the same portal is in itself quite unique and remarkable.”
> www.ehealthonline.org > February 2011
Similarly, realising the challenges of dealing with providing healthcare services to a huge population, Government of Maharashtra decided to use ICT as a tool to enhance their ability to deal with this complex delivery model. Through this project, the entire patient registration and front office management of out and in patients and casualty services was outsourced with an objective of reducing patient waiting time and bringing more professionalism and better patient experience when they approach government hospitals. A model of “Outsourced Service Delivery” was adopted on a monthly payable basis for seven years, wherein the Government absolved themselves of making huge upfront investments thus making the project more affordable. The project became operational since October 2008. Dr TBS Buxi, Chairman and Managing Director, North Healthcare Diagnostics Pvt Ltd sharing his views on the benefits of HMIS in healthcare delivery said, “Dissemination of information to all relevant areas and yet maintaining the privacy of the patient record is paramount. HMIS allows interpretive information to the clinicians and interdisciplinary interactions for quick management of the patient with intelligent life cycle management of the clinical information. PACS is being used for instant transfer of images to important interfaces such as the Intensive Care Units and Operation Theatres for enabling the healthcare professionals to collaborate seamlessly across multiple sites, platforms and specialities for timely, quality patient care.” He adds, “Interactions and discussions between different authorities of various fields of practice are possible across the globe. Comprehensive policies can be monitored easily with efficient and accurate interactions with the finance, engineering and dietetics departments. Pharmacy monitoring for drug usages and interactions becomes more effective. HMIS enhances information integrity, reduces duplication of entries, propagates paperless working, optimises workflow
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Tech Trends – ICT
“The cutting-edge analytical tools of HMIS portal helps consolidate data from different sources and facilitate timely action” Pravin Srivastav Ministry of Health and Family Welfare, Govt. of India
Right now the usage is very limited and only a few states are making use of the data available. A change in mindset is required which can actually come through long term education and training and capacity building programs andallows easy patient data recovery and storage consolidation.”
Substantial Change The achievements of HMIS project in medical and drugs department, Maharashtra are commendable. Unique Health ID generated by HMIS has been issued to approximately 25 Lakh patients that have come to the 4 hospitals which have gone live since Oct 2008. Patient waiting time at the various registration counters have been brought down from 45 min to 10 min even in peak hours. Automatic generation of cash collection and inventory reports has improved efficiency and reduced scope for malpractices and pilferages. The NRHM portal is also going to bring a paradigm shift in terms of overall program management and administration. Commenting on this, Ashok Tiwari, Chairman & Managing Director, iBilt Technologies says, “The NRHM portal is going to bring a
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substantial change in the management and operation of the entire program. It’ll provide health administrators with immense power to analyse field data like never before; monitor progress at every step of the work; and improve success levels and outcomes of program implementation.” The ultimate goal of HMIS is to put data for action at the local level. However, to make this happen, firstly we need data, secondly we need analytical capabilities, and thirdly we need the authority to use this analysis for action on ground. This calls for a huge amount of mindset change that has to go in for making people capable of making their own decisions. However, it is not at all easy to put this in practice. “We are used to filling forms, collecting data and then forgetting all about it. But we need to stop forgetting and start using the data. The cutting-edge analytical tools of this HMIS portal will help consolidate data from different sources and facilitate
> www.ehealthonline.org > February 2011
timely action. It also requires talking to institutions, creating capacity by training and sensitising people who have never before thought about using data in such a way,” says Praveen. Dr Sundeep Sahay, Advisor, National Health Systems Resource Centre said, “Right now the usage is very limited and only a few states are making use of the data available. A change in mindset is required which can actually come through long term education and training and capacity building programs.” The usage can be increased by training, capacity building, providing better tools so that people can easily look at drafts, charts, maps. People are only used to sending information up the hierarchy but they don’t really use it for themselves and for their local actions. The idea is that, in the long-run, data collected at ground level can be made readily available for quick and immediate decision making at the local level. Traditionally, data collected at the local level bear no ownership among local people. Typically, the time lag for data to reach decision makers at higher levels; their subsequent aggregation and analysis into meaningful interpretations; and finally, execution of corrective action on ground is often too long, cumbersome and in many instances, not effective. On the contrary, if local people are empowered to recognise the ownership of their data and are made capable of taking immediate action for potential threats, the benefits will be much better. This will lead to actual realisation of objectives of data-for-action. However, it’ll be a considerable time before able to create requisite capacities at local level and realise the true potential. The efforts have just begun. This is a model that can work for healthcare providers having large volume of patients with varied geographical spread. Investment of the limited available funds could be directed in the model that is working on this project so that more and more state governments can afford ICT implementation.
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Speciality
New Age Diagnostics Cutting-edge Radiology research is creating a revolution in the diagnosis of a range of ailments By Dhirendra Pratap Singh
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ny sufficiently advanced technology is indistinguishable from magic, Arthur C. Clarke once wrote. So it is with Radiology, and its almost miraculous potential to save our lives. Radi-
a clinical specialist. The late 70s and early 80s saw entry of first ultrasound and single slice translate-rotate CT scanners in India, suddenly emerging like sphinx and transforming the status of imaging technology from just simple hardware producing flat two dimensional images into orthogonal cross-sectional images of higher special and temporal resolution which revealed much more in terms of human anatomy and offered higher accuracy in diagnosis. This placed the radiologist in the driver’s seat in the clinical world and brought greater respect to him as the one whose acumen was necessary to get the diagnosis in most cases on which was based management of the diseases. Says Dr Bharat Parekh, ChairmanIndian College of Radiology & Imaging, “The new position of the Radiologist became even more envious with introduction of multi-slice volume CT scanners, superconducting MRIs, SPECT and fusion imaging, and teleradiology. With emergence of interventional Radiology and its advantages of minimal invasiveness in treating diseases, the radiologist came close to becoming a surgeon.” Indian health imaging market is expected to double from the existing `1,575 crore in the next five years. X-ray, ultrasound, CT and MRI would drive this domain collectively accounting for 68.6 percent of the health imaging market. Teleradiology holds 90 percent of the market share in the country, growing at 50 percent year on year. Since the days of X-ray, various technologies have exploded the radiology market. Major evolution has been noticed in the domain of CT, MRI and ultrasound, while digital radiography and teleradiology have given a whole new meaning to diagnosis.
PACS ology is a method used for the evaluation of bony structures and soft tissues. It was not so long ago, when only conventional X-ray imaging was available, a Radiologist was perceived more as a technician or a ‘Medical Photographer/Radiographer’ rather than
The increasing proportion of imaging modalities that generate images in digital form has lead to the development of digital image management systems. Such systems referred to as Picture Archiving and Communication Systems (PACS) are emerging
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Speciality
New Technology, New Prospects DCT Scanner: Dual source CT scanners are the latest revolution in the field of CT imaging. Also, there are multi-slice CT scanners which have the capability of rapidly scanning large longitudinal (z) volume with high z-axis resolution. Multi Slice CT is a light speed VCT. Its unprecedented coverage speed allows clinicians to capture whole organs in a second, the heart in 5 beats, or go head to toe in less than 10 seconds. MRI: MRI scans give the best soft tissue contrast of all the imaging modalities. It has become an important tool in musculoskeletal radiology and neuro radiology. Areas of potential advancement include functional imaging, cardiovascular MRI, as well as MR image guided therapy. Interventional MRI is one of the latest trends in this field. Single Photon Emission Computed Tomography (SPECT) is widely used in modern nuclear medicine diagnostics. SPECT scan, a three-dimensional image is obtained by rotating the detectors of the gamma camera around the patient. While planar lung scans yield sensitivity between 0.76 and 0.81, in SPECT imaging, a substantial improvement up to 1.0 was found. Image Guided Radiotherapy (IGRT) is another big step in the advancement of radiotherapy. IGRT helps to know exactly where the planned IMRT is going. The arrival of the futuristic, highly refined robotic systemCyber Knife has revolutionised radio surgery. In many cancers, the advantages of Cyber Knife and IMRT-IGRT can be combined for optimum effect-least side effects and best levels of cure or control.
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Integration of RIS with PACS is a defining trend in the imaging market. These systems can now automatically predict or rather anticipate specific views to the radiologist in clinical and radiological environments. It is an integrated set of information technology systems designed to provide a complete solution for image management in a film-less radiology department. Says Tarit Mukhopadhyay, Head – HIS & PACS Business, Siemens Medical Solutions, “Emergence of high-end modalities in Cardiology and Oncology requires archiving and post-processing of images where PACS is becoming mandatory.” When introducing PACS to the hospital environment, it is critical to establish a Hospital Information System (HIS) or Radiology Information System (RIS) beforehand. Integration of Radiology Information Systems (RIS) with PACS is a defining trend in the imaging market. An integrated system, which already knows certain information like patient’s history, reason for the examination, and the tests ordered, these systems can now automatically predict or rather anticipate specific views to the radiologist. It lessens the manipulation of image manually and giving more time to the expert for faster evaluations. The radiologists are too few in number compared to the increasing patient load all over the world. In such case, teleradiology improves patient care by allowing radiologists to provide services without actually having to be at the location of the patient. The innovation of digital radiography (DR) system has significantly improved the clinical workflow and efficiency of the department and has also helped shorten the diagnostic and therapeutic decision-making processes. Additional benefits are improved patient comfort, reduction in radiation doses, higher examination throughput (i.e. multiple examinations during one visit) and a more pleasant atmosphere in the waiting
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room (through shortened examination and waiting times for x-ray) as the x-ray images are available at any time, throughout the hospital, in a PACS environment. All represent major benefits for the patient and increased satisfaction.
Cancer diagnoses and therapy It is estimated that in India there are nearly 1.5-2 million cancer cases at any given point of time. Over 7 lakh new cases of cancer and 3 lakh deaths occur annually due to cancer. Recent advances in Interventional Radiology (IR) have enabled the radiolo-
“For PACS to be working efficiently in hospitals, there needs to be a regular curriculum in universities” Tarit Mukhopadhyay Head — HIS & PACS Business, Siemens Medical Solutions
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Speciality
“With emergence of interventional Radiology and its advantages of minimal invasiveness in treating diseases, the radiologist came close to becoming a surgeon” Dr Bharat Parekh Chairman-Indian College of Radiology & Imaging
Interventional radiology has paved the way for applying to conditions that are otherwise performed using invasive methods gist to bring about direct destruction of the tumour. For inoperable liver tumours, Radio-Frequency Ablation (RFA) offers a non-surgical, localised treatment that kills the tumour cells with heat, while sparing the adjacent healthy tissue. Being a local treatment, it is a very safe procedure that does not harm healthy tissue. Similarly, Radioembolisation is a latest technique of intra arterial radiotherapy. It involves delivery of Yttrium 90 labeled microspheres into the blood vessels supplying the tumour. These microspheres get embedded in small blood vessels inside the tumour and emit beta particles which treat the tumour. Since the average penetration of a beta particle is only two millimeters, the radiation therapy delivered is highly targeted and is limited to the area of interest. Prasanna Vadhana Kannan, Research Analyst, Frost & Sullivan says, “Advances in interventional radiology have simplified most of the procedures while retaining safety and fewer traumas to patients. Besides angioplasty, drainage procedures, tumor ablations, and embolizations are now increasingly becoming image-guided
minimally invasive interventions with the refinement of technologies. Successful evolution of IR procedures could be attributed to advances such as improved multidimensional imaging techniques, microcatheter technology, improved guide wires, small sized balloon catheters, vertebroplasty, drug eluting and flexible stents and removable vena cava filters.” Interventional radiology (IR) utilizes various imaging techniques such as CT, MRI to guide percutaneous minimally invasive procedures for both diagnosis and therapy. This has paved the way for applying IR to a vast number of medical conditions that are otherwise performed using invasive methods.
PET scanning In the course of a Single Photon Emission Computed Tomography (SPECT) scan, a three-dimensional image is obtained by rotating the detectors of the gamma camera around the patient. For evaluation, slices in any orientation can be reconstructed from the original three-dimensional scan. PET scanning is a nuclear medicine procedure that deals with positrons. The positrons an-
nihilate to produce two opposite travelling gamma rays to be detected coincidentally, thus improving resolution. With the introduction of improved instruments allowing acquisition of whole body images in under an hour, applications in oncology have opened avenues for expanded clinical use of PET. SPECT is a well-established imaging method that is widely used in modern nuclear medicine diagnostics. In particular, tomographic scans have almost completely replaced planar acquisitions in the fields of cardiology and neurology. Image Guided Radiotherapy (IGRT) is another big step in the advancement of radiotherapy. IGRT helps to know exactly where the planned IMRT is going. The arrival of the futuristic, highly refined robotic system-Cyber Knife has revolutionised radio surgery. In many cancers, the advantages of Cyber Knife and IMRT-IGRT can be combined for optimum effect-least side effects and best levels of cure or control. However, there are still challenges. Says Tarit Mukhopadhyay, Head - HIS & PACS Business, Siemens Medical Solutions, “PACS technicians are not readily available in India. Those who are available learn PACS by usage and are not updated with the latest technology. For PACS to be working efficiently in hospitals, there needs to be a regular curriculum in universities to understand the fundamentals of PACS in a total IT perspective.” Also, there is an alarming rise in the number of medicolegal cases in radiology. Says Dr Bharat Parekh, “Future in Radiology will see enhanced efforts towards greater use of molecular imaging to be able to detect lesions before they attain even pin-head size and which are yet only at cellular levels. By understanding the molecular basis of disease and developing methods to detect and treat changes in the body at the molecular level, physicians will be able to identify diseases in the earliest possible stages.” This will by far remain the major focus of research and development in clinical medicine in the 21st century.
February 2011 < www.ehealthonline.org <
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zoom in
Costing System in Hospitals The growing need of hospitals to have an efficient system to control costs and at the same time maintain quality
By Ravi Mani
M
odern day hospitals provide a variety of services to patients under one roof. It is akin to a large service organisation considering the number of personnel involved and the capitalintensive nature of the business be it the civil structures, operation theatres and equipment, diagnostic and therapeutic equipment, resuscitation equipment, gas lines, surgical instruments, consumables, and so on. Moreover, it is a 24x7 operations with people playing a vital role in the well being of the patients in the hospital. There are various complexities that necessitate the hospital management to put in place robust costing systems. However, traditional hospital managements have not given serious thought to the
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same. The corporate world has adopted and benefited from good costing systems, since the early 1930â&#x20AC;&#x2122;s. The same holds true of modern day corporate hospitals, who believe in providing cost effective services to patients and ensuring patient loyalty to the healthcare provider. Traditionally, hospitals used bed occupancy as the yardstick of measurement of performance. With the advancements in medical technology, the average length of stay (ALOS) is reducing and hence, bed occupancy is not the main performance measure any longer. The increased utilisation of costly resources, e.g. equipment in operating theatres, ICUs, Cath-Lab, Pathology Lab etc. in addition to doctorsâ&#x20AC;&#x2122; times are the key to success in hospitals.
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Importance Until a few years ago, it was practically absurd to think of a marketing function within a hospital. That situation is passĂŠ with almost every hospital worth its salt employing marketing professionals to attract new corporates. Hospitals also employ loyalty cards and discount health cards to attract and retain customers. The advent of health insurance companies has also queered the pitch. With the costs of treatment going up and the privatisation of the insurance industry, the hospitals are forced to give quality service at highly competitive prices as the insurance companies will pay only for the services that are desired and will also monitor the services that are rendered closely. This leads to deductibles, co-payments and all
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zoom in claims by hospitals do not get settled hundred percent. There is also a time element involved as costs are incurred upfront and outstanding amount is received only after a couple of months. It is therefore imperative for hospitals to have a system to control the costs, while at the same time providing high quality service to the patients.
The costing problem Patients undergoing treatment receive services of varied nature from different departments. The hospital has to recover the expenses of the direct departments as also of the support departments from the patients availing these services. Nowadays, any composite hospital with latest facilities for advanced medical/ surgical procedures in the various areas of treatment will have nearly 50 or more revenue centres and about 10 to 15 supporting service centres. Furthermore, most of the revenue centres, particularly, in-patient wards, will have classification depending on the level of services for different class of patients according to their monetary or other needs. Again, each department, other than wards, undertakes several types of procedures/operations etc. All these make the list of procedures and classification of services quite large. It is for this reason that ascertaining true costs of various services and fixing of the Schedule of Charges becomes extremely complex. Costing needs to be done after careful analysis of past data, comparative data from other hospitals, study of utilisation of capacities. Costing techniques shall be applied to provide acceptable costs and charges, enabling optimization of capacity utilization, which, in turn, result in better overall revenues and leave adequate funds for growth and development of newer and advanced facilities.
Setting up a costing system Unlike in other industries, where pricing of products/services is generally uniform except in special cases such as exports, institutional sales etc., in hospitals most of the services rendered are charged at
different rates based on class of patients. Besides, a category of patients are given free or semi-free treatment, where the charges are nil or kept very low. Thus, the final charges or pricing has no direct relevance to â&#x20AC;&#x2DC;costsâ&#x20AC;&#x2122; individually. But, the overall revenue expected from the charges recovered from all patients has to cover the total costs incurred, to make the procedure or department self-supporting. This matching of expected revenue and costs can be done only on the basis of exhaustive analysis of past quantitative and financial data. Thus, detailed statistics play an extremely important role in Costing of services and fixing of schedule of charges. Based on such analysis, discussions with medical personnel of each department, regarding the practical problems and expected quantum of each procedure with class-wise level of patients and detailed budgeting of revenue has to be made. This forms the broad structure for cost allocation to the various cost centers and fixation of individual charges. Keeping in mind the purpose and its importance to the hospital in recovering all expenses incurred, the procedure for cost allocation should be designed so as to obtain accurate and realistic results. We shall not go into the intricacies of these procedures in this article but limit ourselves to the basic steps for the purpose of ascertaining the final costs to obtain the desired results. Broadly, the steps needed include identifying the various cost centers in the institution and arranging them into revenue producing centers by charging patients for the services and supporting non-revenue producing centers, allocating direct expenses to all centers by analysis of each element of cost, developing cost allocation criteria for allocating costs of supporting cost centers to other supporting cost centers and revenue producing centers. Now, each revenue center has the total direct costs of the center and indirect costs representing the allocated expenses of the supporting centers. The total costs thus arrived at for each of the revenue providing centers is to be appropriately
Objectives of a costing system l
Utilisation of resources
l Department-wise profitability analysis l Fixation of doctorsâ&#x20AC;&#x2122; honorarium l
Fixing schedule of charges
l Monitoring of factors affecting pricing
distributed among the various services rendered to the patients by that center. This involves not only finding the nature of the services but also learning the general application of the services to the patients. This should be done in conjunction with the medical personnel and modalities determined for each type of service. Once the costs are available for each profit and cost center, they can be used for the various purposes identified earlier. Typically, to arrive at the above costs, one needs to setup various monitors across the hospital, which will give the necessary data for computing the costs. Computerisation could significantly simplify the process of data collection and analysis. A good hospital management system software should form the basis for the costing system. Whatever be the philosophy of the Management, they need to ensure efficient utilisation of costly resources and they should take informed decisions on pricing. A scientific costing system is a very important tool for managements to fulfill these needs and hence, is imperative for the successful running of a hospital.
About the Author
February 2011 < www.ehealthonline.org <
Ravi Mani CEO 21st Century Health Management Solutions
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news review
Drugs
Dr Reddy’s announces the launch of Pantoprazole Sodium delayedreleased tablets Dr Reddy’s Laboratories has launched Pantoprazole Sodium Delayed-Released tablets (20mg and 40mg strengths), a bioequivalent generic version of Protonix Tablets in the US market. The Food & Drug Administration (FDA) approved Dr Reddy’s ANDA for Pantoprazole Sodium DelayedReleased tablets. Pantoprazole Sodium DelayedReleased tablets had total U.S. sales of approximately $1.8 billion for the twelve months ending September 30, 2010 according to IMS Health. Both strengths
of Dr Reddy’s Pantoprazole Sodium Delayed-Released tablets are available in 90 count bottles. Dr Reddy’s Laboratories Ltd. is an integrated global pharmaceutical company, committed to providing affordable and innovative medicines for healthier lives. Through its three
businesses - Pharmaceutical Services and Active Ingredients, Global Generics and Proprietary Products – Dr Reddy’s offers a portfolio of products and services including APIs, custom pharmaceutical services, generics, biosimilars and differentiated formulations.
Research
Technology
Hypoxia Result in Permanent DNA Changes
Imaging Procedure to Diagnose Alzheimer’s
Researchers at the University of California, San Diego School of Medicine have proven that the genomes of flies exposed to longterm hypoxia are changed to permanently affect gene expression. Their findings are published online by the journal of the Proceedings of the National Academy of Sciences (PNAS). They may lead to new targets for development of therapies for hypoxia-induced disease in humans. The study was conducted at Rady Children’s Hospital-San Diego, Department of Pediatrics. Because cellular mechanisms in fruit flies are very similar to those in human cells, the scientists studied populations of Drosophila melanogaste generated through long-term laboratory selection over 200 generations. These flies are capable of tolerating severe, normally fatal hypoxia, and pass their hypoxia tolerance trait to subsequent generations – the trait persisting even in the absence of hypoxic stress, which suggests a genetic rather than a physiological mechanism is at play in adaption. Using high-throughput screening, the researchers compared the genomics of these flies with those of normal controls, and were able to identify a number of specific DNA regions, mostly on the X-chromosome, related to hypoxia resistance.
A new type of molecular imaging procedure may be capable of detecting the presence of beta-amyloid, a protein linked to Alzheimer’s disease. This preliminary research is conducted by Avid Radiopharmaceuticals. The study provides evidence that a molecular imaging procedure can identify beta-amyloid pathology in the brain, a development that can help to identify Alzheimer’s disease. Florbetapir-PET imaging combines florbetapir F 18, a diagnostic chemical that binds to beta-amyloid, with a PET scan. The researchers used this technique to measure the beta-amyloid levels of 35 patients near the end of their lives, and compared this with beta-amyloid levels after death as determined by autopsy. An analysis of images and other data indicated a correlation between florbetapir-PET images and the levels of beta-amyloid pathology at autopsy. In addition, the Florbetapir-PET scans matched the autopsy results 96 percent of the time. Key- Imaging, Diagnose , Alzheimers, Florbetapir.
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YOUR CA LEN DA R
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Corporate
Product
Erba Mannheim acquires Turkish IVD Co
Devices to Optimise Diabetes Management
ERBA Diagnostics Mannheim, GmbH (Erba), a 100 percent subsidiary of Transasia Bio-Medicals Ltd., (Transasia) - India’s leading IVD Company and a recipient of various prestigious National and State level awards acquired a 100 percent stake in Diasis Diagnostik Sistemler Ticaret Ve Sanayi A.S. [Diasis Diagnostic Systems], a reputed company in the field of IVD, headquartered in Istanbul, Turkey. This is the third international acquisition by Erba Diagnostics Mannheim GmbH in a short span of about 16 months. The first being that of a European IVD company, PLIVA-Lachema Diagnostika, s.r.o. [Lachema] based at Czech Republic having a subsidiary in Russia. The Group already has its presence in over 50 countries through its Distribution and Marketing network. Besides that, Erba-Transasia Group has business alliances with leading IVD companies in the world. Diasis Diagnostic Systems, established in 1993 is involved in the development, production and marketing of products for In Vitro Diagnostics in the field of Biochemistry, Haematology and Urine analysis. It is an ISO 9001/2000 and ISO 13485/2003 certified company and by using its strength in In-House R & D, it has successfully developed over 40 different reagents for Clinical Chemistry and ISE. Besides enjoying a good reputation and market presence in Turkey over the past 17 years, Diasis Diagnostic Systems has also established an export division which exports its manufactured reagents to several countries including Greece, Bulgaria, Pakistan, India, Bangladesh, Korea etc. “We regard the acquisition by Erba as a great opportunity for Diasis Diagnostic Systems to aggressively promote the full range of Erba and DDS products in Turkey, Iran, Syria, Azerbaijan”, according to Ruchan Ozatay, Director of Diasis Diagnostic Systems.
As Noval methods of blood glucose monitoring and evaluation have enabled treatment adjustments that would not have been made on the basis of intermittent finger prick readings, thus dramatically improving the quality of the lives of millions of diabetics around the world. Unlike standard monitoring of blood glucose level up to a maximum four times a day, CGMS monitors and records blood glucose levels 288 times in a day for 3 continuous days. This device is very convenient to use. The CGMS is typically inserted in the abdominal area and worn by the patient three days as they go about their normal activities like exercise, swimming etc. These devices are particularly useful for children with type 1 diabetes, pregnant women with diabetes, and for patient with long standing diabetes who do not get warning symptoms of low blood glucose.
Technology
International
First Genetic Test for IVF Success
Action Plan to Halt Malaria Drug Resistance
Scientists have developed the first genetic blood test for predicting the chances that in vitro fertilization (IVF) will lead to a successful pregnancy. The test is based on the finding that different subtypes of the FMR1 gene in potential mothers are associated with significantly different chances of conceiving with IVF. This is the first evidence that a specific gene appears to be directly associated with IVF outcomes. The study result says that the FMR1 gene, some forms of which are known to predict premature ovarian failure, could be used to predict at what age a woman’s fertility is going to start decreasing. Women with the “normal” FMR1 genotype had a 38.6 percent pregnancy rate; those with the “heterozygous-normal/ high” genotype had a 31.7 percent pregnancy rate; and women found to have the “heterozygous-normal/low” genotype had a 22.2 percent pregnancy rate.
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The United Nations health agency launched a new action plan to halt the spread of resistance to artemisinin, the world’s most potent treatment for malaria, warning that the tremendous gains made in recent years against the disease are under threat. Launched by the UN World Health Organisation (WHO) and the Roll Back Malaria Partnership (RBM), the plan outlines actions to contain and prevent resistance to artemisinins, which are the critical component of artemisinin-based combination therapies (ACTs), the most potent weapon in treating falciparum malaria, the deadliest form of the disease. Resistance to artemisinins has already emerged in areas on the CambodiaThailand border, according to WHO, which warns that if these treatments fail, many countries will have nothing to fall back on. The Global Plan aims to prevent artemisinin resistance by stopping the spread of resistant parasites, increase monitoring and surveillance for artemisinin resistance.
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news review Research
Life Sciences
Protein behind Rheumatoid Arthritis Found
New Vaccine for TB Developed
Researchers at Imperial College London have discovered a protein that triggers rheumatoid arthritis. They found a protein called IRF5 that acts as a switch, telling immune system cells, called macrophages, to promote or stop inflammation. Blocking the production of IRF5 could help in a range of diseases including RA, lupus and even MS. The research is published in Daily Express. Rheumatoid arthritis is an incurable immune system disease where joints are swollen by inflammation. The body uses inflammation as a defense against infection and tissue damage, but too much is harmful..
A team of Dutch scientists at the Statens Serum Institute in Copenhagen, an effective vaccine to fight tuberculosis (TB) before and after infection has developed. The vaccine which can both protect against initial infection and protect from a breakdown of infection into disease is a major breakthrough. The vaccine was featured in medical journal ‘Nature Medicine.’ TB is a global epidemic that has targeted people living in developing countries where antibiotics are not sufficiently available to treat the millions who are infected. TB is a disease of the lungs, with coughing, chest pains and weight loss as its symptoms. The Mycobacterium tuberculosis, after invading the body, continues to exist in a latent state. This latent stage enables it to become immune to vaccines as it waits to reactivate itself once the effects of the vaccine are
gone. The reactivation can happen even after decades. The BCG which has been used is effective only if it is administered before exposure to the bacterium. The new vaccine, however, combines proteins that trigger an immune response to both the active and latent forms of Mycobacterium. The efficacy the new vaccine has been eagerly awaited by AIDS patients who face the threat of dying of TB because of their weakened immunity.
February 2011 < www.ehealthonline.org <
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news review Market
Corporate
First Patient in Chennai Treated with ABSORB Apollo Hospitals has successfully treated a coronary artery disease patient with the company’s revolutionary ABSORB drug eluting Bioresorbable Vascular Scaffold (BVS), thus becoming the first hospital in Chennai to use this innovative product. Abbott’s ABSORB is a groundbreaking device currently in clinical trials that is designed to restore blood flow by opening a clogged vessel and providing support while it heals. Once the vessel can remain open without the extra support, the bioresorbable scaffold is designed to be slowly metabolised and eventually dissolve and disappear from the body. Apollo Hospitals is the first in Chennai and one of the few hospitals in India to enroll a patient into the ABSORB EXTEND trial, a worldwide trial of up to 1,000 patients at 100 centers in Europe, Asia Pacific, Canada and Latin America. To date, approximately 200 patients have been implanted with the device, and data have been presented on patients at various time intervals,including 30 patients out to four years. Dr Pratap Reddy, Chairman, Apollo Hospitals said, “Introduction of this new device - Abbott ABSORB is part of our endeavor to bring in cutting edge technology to prevent and give the best possible outcome for coronary artery disease. I commend Abbott for developing this innovative product, Dr Mathew Samuel Kalarickal father of angioplasty for bringing this product first time to Chennai and Dr Sai Satish for bringing in a patient centric approach to cardiology.
ECG Telemetry Devices market to reach $1.1bn A report by Global Industry Analysts say that the global market for ECG telemetry devices is estimated to reach $1.1bn by 2015. The market will be driven by increasing cases of cardiovascular diseases and an ageing population. In addition, an increase in the number of modern chest-pain clinics and technology innovations will promote the increased adoption of telemetry ECG systems. The US represents the largest regional market for ECG telemetry devices in the world and, according to the report, the market will be driven by the increasing number of US citizens receiving home care. Asia-Pacific represents the fastest growing market for ECG telemetry devices. It is estimated to grow at a CAGR of more than 5% over the study period. Central display, control and recording stations is the largest product segment of ECG telemetry devices, while electrical leads will be the fastest growing, the report added.
Product
International
Glaucoma Detector for deteting glaucoma
Medtronic Provides Funding to Haiti
Scientists at the University of Arizona in the US have developed an instrument for detecting glaucoma, a disease caused by increased fluid pressure inside the eye. The project was funded by The National Science Foundation. The device is designed for self testing, and requires an individual has to rub a probe over the eyelid. This device, which can also measure drainage of intraocular fluid, uses a system of micro-force sensors and specially designed microchips, detects the stiffness of the eyelid and calculates the intraocular pressure.
Medtronic has announced funding of $750,000 to support healthcare infrastructure development in Haiti. The grant by Medtronic completes the $2.1m commitment the company made after the January 2010 earthquake in Haiti. About $500,000 will be provided to Partners in Health to facilitate the completion of construction of public hospital in Mirebalais. The hospital will improve clinical care and technical capacity, will accommodate a wider range of diagnostics and therapeutics, and serve as a major teaching hospital. The grant by Medtronic completes the $2.1m commitment the company made following the January 2010 earthquake in Haiti.
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